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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />Nn 1001 <br />PAID 4 7a). 66 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />0 f &u,0% 1.a 4 i 61-1-- VS 142 <br />(Name) (Address) (Phone) <br />Owner/� r /) 57 ,/ 7 <br />l/'ti < l"-U,�S'C'7 �l�' / C l.rluiru717 �/� 6'Y Ll14l; (ii'/Iii{-o/'r- /1),() - 69- 0i-c!L' <br />(Name) (Address) '(Phone) <br />Property Location (Street Address and Legal Description): <br />66/ eCV /J7c D . � Z � dsbu, JA, 4»U7/7 <br />Description and /or Reason for Request (Cite Ordinance Sections): 5:1c7 <br />/2 <br />SU 19 .) , i� ; 9a— /1")70 <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />(Signature f Applicant) (Date) <br />WHITE— Office CANARY— Customer PINK —File GOLD— Planner <br />